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HIX Digest for the week of December 17, 2012

In this week's HIX Digest: Utah's pre-ACA HIX seeks certification, Iowa's partnership plan gains support and West Virginia mulls enrollment challenges.

Utah's pre-exisiting HIX seeks certification

A mid-December Rasmussen poll of 1,000 American voters found 46 percent support a state-based health insurance exchange, while 35 percent are opposed to the idea, with respondents pretty much evenly split across the states.

That finding comes as the tally for state HIX decisions continues to trickle in, with Florida and Utah still remaining undecided. Those two states, coincidentally, have pre-Affordable Care Act state-created HIXs that may or may not be able to be ACA certified.

Officials at the Florida Health Choices small business HIX say they have no plans to seek ACA certification. Meanwhile, Utah Governor Gary Herbert, a Republican, has asked the Obama administration to "instruct the Department of Health and Human Services to certify the current Utah version of an exchange."

Utah's exchange, created in 2009, is currently available only to small businesses. Now called AvenueH, the exchange bills itself as "consumer-based model," with many choices and few restrictions, and it sells small group and defined contribution health plans, from insurers including Select health, United Healthcare and Regence Blue Cross Blue Shield of Utah. The exchange also has a prominent role for brokers, in a bid to preserve traditional aspects of small business insurance.

AvenueH was not designed to be as comprehensive as exchanges required by the ACA. "We never intended for our exchange to administer Medicaid, enforce the individual mandate or distribute federal tax credits," Herbert wrote.

Even so, Herbert wants HHS to certify the Utah exchange as the minimum baseline for state-based exchanges. "I am confident that if you make this change, several other states will join Utah and request certification for state- based exchanges based on our model."

Iowa partnership HIX gets support

Iowa Governor Terry Branstadt diverged from most other Republican-led states in picking a state-federal partnership HIX, although he said he choose it as the sort least-worst option, citing concerns of cost and regulatory uncertainty with a state HIX and the potential for government overreach with a federal HIX.

"We will continue to regulate insurance plans in Iowa and retain control over our Medicaid and Children's Health Insurance Plan eligibility," Branstadt told the Department of Health and Human Services. "If our sate loses control of the costs of these programs, other funding priorities like education, public safety and workforce development may be threatened."

In an editorial, the Iowa City Press Citizen endorsed the partnership HIX as "a much better option than having Iowa leaders rush to set up its own system without having done all their homework."

Under the partnership exchange -- also being pursued by Illinois, Arkansas, West Virginia, North Carolina and Delaware -- the federal government provides most of the investments in IT systems, something the Press Citizen thinks is a boon for Iowa, letting the government focus on other funding priorities.

WV looks to enrollment challenges

In West Virginia, where Democratic Governor Earl Tomblin chose a partnership exchange, state officials are talking up plans for maximizing HIX enrollment.

"The member-per-month cost will go down the more people who are enrolled," state senator Dan Foster, a Democrat from outside Charleston, told West Virginia Radio. "We need a better system to help those people to get enrolled."

The state's Insurance Commissioner, Mike Riley, told lawmakers the exchange will probably use a combination of outreach tools, including telephone, television and internet marketing, as well as insurance agents.

Some lawmakers told Riley they were concerned the state's lack of broadband and high-speed internet would be an obstacle to advertising and enrollment.

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